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Spinal Fluid Tests May Predict the Course of Parkinsonís

- Sep 13 2013

According to a new report, people with early-stage Parkinson’s disease (PD) may have lower levels of four proteins in their spinal fluid, as compared to healthy adults. These proteins have potential as biomarkers for diagnosing PD and for predicting the progression of the disease. The research appears in the August 26 online edition of JAMA Neurology.

Parkinson’s is diagnosed based upon observation of its symptoms. There is not yet an objective test (a blood test, scan or other measurement) that can diagnose a person with Parkinson's, or predict his or her progression over time. In recent years, researchers have made progress in being able to identify subgroups of people with PD who develop some symptoms more severely or rapidly than others. For instance, researchers have found that PD tends to progress more quickly in people whose early symptoms are mainly difficulties with balance and walking, rather than tremor.

The new study is the first result reported from a large, multicenter effort to seek PD biomarkers, called the Parkinson’s Progression Markers Initiative, an initiative of the Michael J. Fox Foundation for Parkinson’s Research.

Researchers led by Leslie M. Shaw, Ph.D., at the University of Pennsylvania, analyzed spinal fluid from 63 people with early stage PD who had not yet started treatment, and 39 healthy adults of similar age and level of education. They measured levels of four proteins in the spinal fluid.

Results

Overall, in people with PD, the average level of all four proteins was lower than the average levels for people without PD.

Based on average levels of proteins, researchers were able to identify groups of people who were likely to have Parkinson's, to identify people whose Parkinson's symptoms were more severe, and to predict who may have had a particular type of PD in which the more problematic symptoms are balance problems and walking.

What Does It Mean?

Finding biological markers for PD is critical for advancing research. Biomarkers may help doctors to diagnose PD earlier, or to better monitor disease progression, or both. In turn, this would not only improve care for people with Parkinson's, but might also help clinical trials.

Although the results of this study are promising, further investigation is needed. First, the number of participants was small and larger studies are needed. Additionally, it is important to note that while people with PD showed lower averageprotein levels than people without PD, the ranges of protein levels overlapped between the two groups. This means that right now, while the test may help researchers, it would not be helpful in diagnosing or predicting PD progression for an individual.

For a person living with Parkinson's disease, the idea of spinal fluid collection can be concerning. Yet it is considered a very safe procedure. Its main side effect is a severe headache.

In many other neurological diseases, including multiple sclerosis and some types of dementia, spinal fluids are very helpful clinically in the diagnosis and monitoring of the disease. It is very possible that in the future, this test, may be an important clinical tool in PD as well.